Timing of the First Bath Show
The World Health Organization recommends delaying the first bath until at least 24 hours after birth. It has been suggested that delaying the first bath has a positive effect on bonding, breastfeeding and in the prevention of hypothermia and hypoglycaemia 1. However the exact timing of the first bath should be specific to the individual needs of each baby and their parents/carers. Newborn Skin The newborn baby’s skin differs from mature adult skin in structure, function, and composition 2, 3, 4 and is particularly susceptible to infection 5. The pH value at birth is slightly higher and is almost close to neutral. Following birth there is a progressive decline in the pH from day 3 to day 30 as the body develops its protective acid mantle, a slightly acidic film on the surface of the skin which acts as a natural bacterial protection 6. Introduction of baby bathing products at this time such as wipes and creams can disrupt this delicate protective layer. Bathing products It has been recommended that liquid cleansers should not be used for babies during the first four weeks and plain water should be used for bathing 7, 8. No creams or lotions should be routinely applied to dry or cracked skin. In the event of persistently dry skin, use of a preservative-free paraffin-based emollient such as liquid paraffin 50% in white soft paraffin is advocated. It is recommended that the first immersion bath (Box 1) will take place at least 24 hours after birth 1. The first immersion bath should take place at a time convenient for the parents/caregivers. The baby should be clinically stable and able to maintain its own temperature within normal ranges of 36.6-37.3. N.B. Babies born to HIV positive mothers should have their face and eyes cleansed immediately following delivery and their first bath carried out as early as possible if temperature satisfactory.
The benefits of daily bathing have not been clearly demonstrated, therefore decisions about the frequency of bathing should be based upon individual needs and family values and beliefs. As a general guide, it is reasonable to suggest bathing well, term babies on alternate days 16. Healthy Term Infants should be bathed in plain tap water during the first 4 weeks of life 7, 8. No creams or lotions should be routinely applied to dry or cracked skin. In the event of persistently dry skin, use of a preservative-free paraffin-based emollient such as liquid paraffin 50% in white soft paraffin is advocated. In the clinical areas all such preparations require to be prescribed on the baby’s drug kardex prior to administration. Bathing products can be gradually introduced 4 weeks following birth, however they should be free from colours and perfumes, have a neutral pH and be used sparingly. Apart from plain water wipes, baby wipes should be avoided for the first 4 weeks and once introduced, should be mild and free from alcohol or perfume. The procedure and principles outlined in Box 1 (above) should be applied, with emphasis being placed on parent participation and education. Parent Education Gaining confidence in handling and bathing their baby for the first time can be an exciting but also stressful time for parents. It is therefore crucial that parents are involved and encouraged to participate in their baby’s bath if possible before taking their baby home. There is a wealth of information available both in written format and online for parents to review. There is available online information for parents within NHS GG&C covering a range of topics from bathing to napkin care and feeding 17. Bathing Your Baby NHS Information- Video for parents
https://www.nhs.uk/conditions/baby/caring-for-a-newborn/washing-and-bathing-your-baby/ Staff caring for sick babies in the clinical area should assess and plan care on an individual basis in relation to the specific needs of the baby in partnership with parents. Skincare should be performed to maintain the integrity of the baby’s skin, help prevent infection and maintain comfort. It is also an important opportunity to assess the skin and identify and monitor any potential problems. During periods of acute illness, skincare should be performed as required to ensure that the skin is clean and dry and any waste products are removed. While an immersion bath cannot be performed on a relatively unwell baby, particular care should be taken to ensure that areas such as the axilla, neck, skin folds and fingers are kept clean and dry. The baby’s skin should be cleansed with warm, plain, tap water or plain water wipes only. Any concerns over skin integrity should be discussed with the tissue viability team and a plan of care developed. Progress from incubator to immersion baths will take place when the baby is transferred from a closed incubator to cot / babytherm / basinet. A record of baby bathing should be recorded in the baby’s care plan/nursing notes. The importance placed on bath time for newborn babies and their families is well recognised. However despite the many benefits, it can be a stressful time for both parents and babies. Routine immersion baths can cause considerable distress particularly to the preterm infant, triggering adverse physiological and behavioural responses such as increased heart rate and cardiac oxygen demand 18 . Furthermore the preterm and VLBW infant has an incompletely developed thermoregulatory system, making them highly vulnerable to changes in environmental temperature 19 . In preterm infants who have poor temperature control bathing can cause hypothermia, which can occasionally lead to further complications such as hypoglycaemia, apnoea, acidosis and pulmonary insufficiency. Hypothermia remains a major contributor to newborn mortality worldwide and is a common problem for low birth weight infants20. Therefore the bathing procedure for this group should be modified to minimise the preterm infants’ exposure to excessive stimulation, reduce the stress experienced and maintain a normal body temperature 21. A supportive method of bathing baby which applies the principles of gentle touch and containment is called “Swaddle Bathing” (Figure 1). Fig 1: Swaddle Bathing  Swaddle Bathing The swaddle method of bathing is reported to reduce the stress associated with traditional immersion baths and help maintain normal body temperature 22 . It is recommended for the preterm neonate however can also be used with well term babies. It has been reported that compared to traditional immersion bathing , swaddle bathing resulted in decreased physiological and motor stress decreased crying and agitation and less temperature instability 23 . Swaddle bathing is consistent with developmental theory and promotes family –centred care 22. A quality improvement project carried out in a Neonatal Unit concluded that when swaddle bathed, infants do not loose heat, cry less and the bathing experience appears less stressful and much more enjoyable for infants and their families. 24, 25. Which babies can have a swaddle bath?
The swaddle bath should take place prior to a feed or when cluster care is performed. If this is not possible it should be started at least an hour after a feed 25. It is particularly important that supporting and handling the preterm baby with gentle touch and containment is applied throughout bathing to reduce signs and levels of stress 12 . Parents should be fully involved in the swaddle bath (Box 2) and work up to swaddle bathing their baby independently. A video demonstration of swaddle bathing can be viewed at: https://youtu.be/wQfjPSQre58. Courtesy of Michele Brooks, Practice Educator and Gill Currie Advanced Practitioner OT, Neonatal Unit University Hospital Wishaw. Box 2
What precautions does the nurse take while providing skin care to a preterm infant?For preterm infants younger than 32 weeks, gently cleanse skin surfaces with warm water only during the first week of life. Use soft materials and avoid rubbing the skin; instead, squeeze water onto the skin during rinsing. Use warm sterile water when breakdown is evi- dent (AWHONN, 2013).
Which explanation to the newborn's mother is most appropriate when she finds a small amount of blood on her baby's diaper?Newborn girls may have a small spot of blood in the diaper, also usually in the first week after birth; this blood is caused by her mother's hormones affecting the baby's uterus.
What should the nurse be aware of with regard to umbilical cord care?Keep the belly button area dry. You may need to fold the top of the diaper down. Change your baby's diaper frequently, with every feeding. A wet diaper on the cord keeps the cord from drying and increases the risk of infection.
When should the nurse complete a second assessment for the newborn?Apgar at 5 minutes of age: As the nurse continues to closely monitor the newborn, a second Apgar score is assessed at 5 minutes of age. This score can be obtained as the newborn and mother continue skin-to-skin contact.
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Which statement provides helpful and accurate nursing advice concerning bathing the newborn
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